Facelift surgery, or rhytidectomy, addresses aging in the lower third of the face primarily, but can also give some improvement to the middle third. It restores a more youthful appearance by reducing the sagging skin which causes major wrinkles, jowls, and a “turkey gobbler” neck. The jawline and neck are improved and the skin is made smoother. A facelift can make a patient look dramatically younger and last for many years. This improvement, however, requires a significant investments by both the surgeon and patient. While facelift results do not last forever, your face will continue to look better than if you never had the procedure. The procedure can be repeated as the unstoppable effects of gravity continue. Minimal incision facelifts , or “mini lifts”, are much talked about and may be appropriate for a few select patients. Most often, however, minimal facelifts give minimal results.
Patients should cease smoking and taking aspirin and ibuprofen for at least 3 weeks before surgery. Full facelifts are performed in an operating room setting under anesthesia. The surgeon makes incisions hidden around the ear and hairline. Excess skin is removed and sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Incisions are closed with small sutures. A facelift is frequently performed in conjunction with blepharoplasty (eyelid surgery), forehead lift, chin augmentation, and/or liposuction, to create an overall rejuvenation of the face
Your OR time will vary depending on the operation as well as other factors. The operation commonly lasts from 5-6 hours. You will may be discharged the same day or stay overnight depending on your pain level, overall health, and other factors.
You will be discharged with a head wrap and a surgical drain. These will be removed in approximately 24 hours. You may have some oozing which is not unusual. You may shower and wash your wounds and hair on post op day 2 after removing your dressing.
You will be provided a narcotic for pain control. Do not use ice or heat unless specifically discussed with Dr. Wigod. Your symptoms should improve rapidly during the first few postoperative days and then resolve more slowly. You may begin light exercise such as walking as soon as you feel able, but avoid sweating for 2-3 weeks post op. Eat soft foods only for the first week post op. Sleep with you head elevated for about 1 week to minimize swelling. You should avoid heat and sun exposure.
Your skin will be closed with a combination of absorbable and non-absorbable sutures. Your sutures in front of your ears will be removed in one week post op and sutures behind your ear and in your hair at 2 weeks post op.
Complications following a facelift are relatively rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and scarring. Risks are increased in smokers. Your face may feel weak, numb, swollen or bruised for several weeks post op. The healing process is gradual, so you will not see your final result until about 6 months post op.
Read more about facelift from the American Society of Plastic Surgery »
The upper third of the face is defined as the forehead, brow, and upper eyelids. While less well known to patients, a Brow Lift is the most appropriate procedure to produce dramatic improvement to this important aesthetic unit. A properly executed Brow Lift raises and separates furrowed and drooping eyebrows and smoothes the forehead to create a more youthful appearance. Good technique and judgment will avoid a surprised look or an overly elevated hairline. This procedure can be performed in conjunction with other surgeries such as facelift or browlift.
For a Coronal Brow Lift, an incision is generally made across the top of the head from the front of one ear to the front of the other ear. The forehead and brows are elevated and excess skin is removed. The flap is then sutured. Patients with a high forehead have an incision placed at the hairline to help reduce the forehead height. Patients without excessive brow droop or with thinning hair may benefit from an Endoscopic Brow Lift. In this procedure, the lift is performed through several small scalp incisions with the aide of a video telescope and special long instruments. Dr. Wigod will discuss the merits of each technique and suggest the most appropriate one for you.
Patients are usually discharged to home on the day of surgery. Swelling, bruising and weakness may occur, but should improve within a few weeks. There may be long lasting numbness behind the incision. Patients may wash their hair on the second day after surgery. Most patients return to regular activity in one week. Sutures are generally removed in one to two weeks.
Eyelid Lift (Blepharoplasty)
Age, sun exposure and hereditary factors all contribute to wrinkles, deep lines and puffiness around the eyes. Eyelid aging can cause unwanted changes in expression, causing us to look permanently fatigued and older than we really are. In some cases, redundant upper lid skin can even contribute to visual impairment. An upper or lower eyelid lift, or blepharoplasty, can restore a more youthful appearance to your eyes. Dr. Wigod can help you decide which of the several operation types is right for you.
In traditional upper lid blepharoplasty, an incision is made in the crease of the upper lid and excess skin, fat, and muscle is removed. Once healed, the incision is hidden when the eye is open and often barely noticeable when the eye is closed. In traditional lower lid blepharoplasty, an incision is made along the lash line and excess skin, fat, and muscle is removed. Once healed, the incision is usually hidden by the lashes. With the transconjunctival approach, an incision is made inside the lower lid. Fat can be removed or redistributed through this incision. Excess skin may still be reduced with a pinch excision hidden underneath the lashes.
Canthopexy or canthoplasty are techniques which are used when the lower lid has poor tone and extra support is required to avoid unattractive and potentially dangerous lid retraction after skin removal. When performing lower lid blepharoplasty, care must be taken to remove just the right amount of tissue to give the best aesthetic result while avoiding complications.
Blepharoplasty may be performed alone or in combination with other operations. Local anesthetic with IV sedation or general anesthetic may be used, depending upon your preference. The operation times vary, but you will be able to return home the same day. Complications are not common, but may occur. The most concerning ones include prolonged swelling, infection, asymmetry, double vision, dry eyes, upper lid drooping, lower lid retraction, and vision loss.
The area surrounding the eyes will remain swollen in the days following the surgery, but should improve rapidly. Some vision blurring and mild pain are normal.
Sutures will be removed in 4-7 days. Swelling and bruising will persist for about 10 days, but makeup can help conceal this. You may expect to resume normal activity rapidly and start enjoying your new look within approximately 10-14 days. It may take up to 6 months for the scars to lose their redness.
Although results may be long lasting, signs of aging around the eyelids will recur.
Nose Surgery (Rhinoplasty)
Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone and cartilage. Appropriate goals for surgery include the following:
- Balance the size of the nose with the other facial features
- Modify the width of the nose at the bridge (dorsum)
- Improve the nasal profile, including removing humps or depressions
- Contour a nasal tip that is too large, “boxy,” drooping or upturned
- Change the angle between the nose and the mouth
- Narrow and reshape the nostrils
- Correct asymmetry or deviation
- Improve breathing through the nose
- Dissatisfaction with previous nose surgery
Conditions to be improved may be natural or due facial trauma. The operation may also help patients who have difficulty breathing and may be performed on most age groups.
Dr. Wigod will discuss with you in great detail your desired changes. He will then examine your nose completely, including your internal nose to detect any breathing problems. Before proceeding to surgery, you and Dr. Wigod will develop and agree on a plan best suited to meet your expectations. He may also use the VECTRA 3D Imaging System to optimize this important process. Your insurance company may pay for portion of the costs associated with your surgery if it is performed as a result of nasal obstruction or recent trauma. Insurance will not pay for cosmetic problems.
Surgery is usually performed under general anesthesia. In most cases, the skin of the nose is separated from the underlying skeleton of bone and cartilage by making an incision under the nasal tip and continuing it along the edge of the nostrils. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum which contributes to breathing difficulty or who require cartilage grafts will need a septoplasty. The nose is then carefully closed, splinted, and sometimes temporarily packed with Vaseline gauze. For nose problems involving only a dorsal hump, the rhinoplasty may occasionally be performed by making incisions inside the nose only. Rhinoplasty may be combined with chin augmentation to balance the nose with a small chin improve the overall profile.
Your OR time will vary depending on the operation as well as other factors. The operation commonly lasts from 2-4 hours and you will go home the same day.
You will be discharged with a plastic splint on your nose which should remain undisturbed and will be removed one week post op. Keep the splint dry until removal. You may also have a splint inside your nostrils which will be removed at 1-2 weeks. You may have some oozing which is not unusual. Your skin sutures will be removed one week post op.
Expect pain and swelling. You may use cold packs periodically. Sleep with your head elevated for about 1 week to minimize the swelling. Bruising occurs around the eyes, but begins to fade within a few days and usually disappears in two weeks. Overall, your symptoms should improve rapidly during the first few postoperative days and then resolve more slowly. Pain should limit your activity. You may begin light exercise such as walking as soon as you feel able, but avoid sweating for 2 weeks post op. Eat soft foods only for the first week post op. If you have problems breathing, an antihistamine may help. Your nose may feel numb or swollen for weeks to months post op. You will not see your final result until 6 months to a year post op. Your nose will continue to change with time as the operation does not stop the normal aging process.
The chin is an often overlooked aesthetic unit of the face. Enlarging a small or weak chin to balance the nose and rest of the face may make tremendous difference in your profile. A proportionate chin may make the nose look smaller, take up flabby neck skin, or give a more masculine look for men. Placing a chin implant can accomplish all of these goals in a durable, cost-effective, and minimally invasive way. Patients with dental problems such as poorly aligned teeth (malocclusion) from a recessive mandible are best served by seeing an oral-maxillofacial surgeon to consider more invasive advancement procedures. The chin may also be accentuated with face and neck liposuction.
To schedule a consultation or for more Face Procedures information, please visit our contact page or call our office at 208.377.9515.